Anti-cyclic citrullinated peptide antibodies as a tool in diffrentiating patients with rheumatoid arthritis from patients with chronic hepatitis C infection-associated polyarticular involvement

To assess the utility of anti-cyclic citrullinated peptide [anti-CCP] antibodies in distinguishing between patients with rheumatoid arthritis [RA] and patients with polyarticular involvement associated with chronic hepatitis C virus [HCV] infection. All the patients enrolled in this study were examined in the outpatient department of medicine unit at Lady Reading Hospital Peshawar from February to December 2010. Serum anti-CCP antibodies and rheumatoid factor [RF] were evaluated in 29 patients with RA, 13 patients with chronic HCV infection a associated with articular involvement and 35 patients with chronic HCV infection without any joint involvement. Anti-CCP antibodies were detected in18 of 29 [62.1%] patients with RA, 7 of 13[53.8%] patients having HCV with RA like arthropathy but not in a single patient with chronic HCV infection with no articular involvement. Conversely, RF was detected in 25 of 29 [86.2%] patients with RA, 9 of 13 [69.2%] patients with HCV-related RA like arthropathy and 8 of 31 [22.9%] patients with HCV infection without joint involvement. This concludes that anti-CCP antibodies can be useful in discriminating patients with RA from patients with HCV-associated arthropathy

relationship between the clinical manifestations and the presence of anti cyclic citrullinated peptide antibodies in very early rheumatoid arthritis

To establish whether the clinical presentation of anti-cyclic citrullinated peptide [Anti-CCP] antibodies and negative disease are distinct at the earliest clinically apparent phase of disease. Patients were seen in outpatient department of Lady Reading Hospital Peshawar from February 2009 to February 2011. Participants were included in the current study if they presented within 3 months of symptom onset and fulfilled 1987 ACR criteria for [RA] in the beginning or at some point during an 18 month follow-up. Data were collected on demographic variables and joint symptoms [tender and swollen joint counts]. C- reactive protein [CRP], erythrocyte sedimentation rate [ESR], rheumatoid factor and Anti-CCP antibodies status were measured. 110 patients were included [57 were Anti-CCP antibodies positive]. The Anti-CCP antibodies positive and negative groups were comparable in terms of demographic variables, inflammatory markers,tender and swollen joint counts and 1987 ACR classification criteria. Rheumatoid arthritis factor was detected more in Anti-CCP antibodies positive patients as compared with Anti-CCP antibodies negative patients. [83.3% vs. 35.8%]. There was no significant difference in the pattern of joint involvement, except for an increased prevalence of knee joint swelling in Anti-CCP antibodies positive patients [56.1% vs.17.5%]. Patients with and without Anti-CCP antibodies present in a similar way, even within three months of clinically apparent disease that eventually develops into Rheumatoid arthritis

Short-term effectiveness of leflunomide in the treatment of active rheumatoid arthritis

To measure the effectiveness of 6-month treatment with Leflunomide in patients with active rheumatoid arthritis. This descriptive study was conducted in Medical B Unit, Lady Reading Hospital Peshawar from August 2008 to August 2009 and included 103 active Rheumatoid Arthritis patients who received Leflunomide 20mg daily for 6 months. The primary effectiveness endpoint was a >/= 20% response according to the American College of Rheumatology criteria 20 and disease activity score 28 response after 6 months. All the 103 selected patients were treated with Leflunomide. The mean age was 56.12% +/- 4.796 years. According to the disease activity score 28, 46.6% of patients had a good response, 41.7% had a moderate response and 11.7% were non-responders. Improvements in tender joint count were-8.63 +/- 3.418 [from baseline of 15.74 +/- 2.9], in swollen joint count were-4.26 +/- 3.058 [from baseline of 9.34 +/- 2.383], Erythrocyte Sedimentation Rate improves to 14.74 +/- 11.527 from baseline of 60.58 +/- 9.608 and physical global assessment improves to 17.38 +/- 15.35 from baseline of 70.24 +/- 7.933. The American College of Rheumatology criteria 20 response criteria show improvement in 87.4% patients. Treatment related adverse events were reported in 23.3% of patients. 17% of total patients discontinue the due to non compliance and side effects. This 6-month study carried out under daily routine practice conditions showed a favorable treatment response for Leflunomide in a dose of 20 mg daily in a typical sample of Rheumatoid Arthritis patients

Short-term effectiveness of methotrexate in the treatment of active rheumatoid arthritis

To determine the effectiveness of 6-month treatment with methotrexate in a dose range of 5-15mg once weekly in 103 patients with active rheumatoid arthritis. This descriptive study was conducted in outpatient department of Medical B unit Lady Reading Hospital from October 2008 to August 2009 and included 103 active rheumatoid arthritis patients who received methotrexate in a dose range of 5-15mg once weekly for 6 months. The primary efficacy endpoint was a >/= 20% response according to the American College of Rheumatology response criteria 20 and disease activity score 28 after 6 months. Female patients made up 51.5% of the study population while males were 48.5%. The mean age was 46.1 years and the mean disease duration was 10.90 +/- 3.42 years. According to the disease activity score 28, 30.1% of patients had good while 38.8% had a moderate response. 31.1% were non-responders. Mean improvement in tender joint count were -8.3 +/- 4.59 [from baseline of 15.54 +/- 5.85] and in swollen joint count were -7.37 +/- 3.98 [from baseline of 10.59 +/- 4.96]. ESR improved to 15.24 +/- 10.42 from baseline of 58.7 +/- 11.16 and physical global assessment improves to 34.42 +/- 20.43 from baseline of 66.21 +/- 10.58. At 6 months, the rate of American college of rheumatology response criteria 20 was 68.2%. Treatment related adverse events were reported in 27.2% of patients. The study showed a favorable effectiveness for methotrexate in a dose range of 7.5-15mg once weekly